Spotting Between Periods: Common Causes and When to Check

Spotting between periods is light bleeding from the vagina on days when you do not have your period. It is not usually serious, but always get it checked by a doctor, because the cause is often easy to find and some causes need treatment.

The most common causes are hormonal contraception, ovulation, small growths in the womb such as polyps or fibroids, and infections. This guide explains each cause, what to write down before your appointment, and which signs mean you should get help soon.

What counts as spotting

Spotting is light bleeding between your periods. It is much lighter than a period. It is often pink, red or brown, and you may only see it on toilet paper or as a few marks on your underwear.

Bleeding between periods is different from a heavy or long period. If your periods soak through pads quickly or last more than 7 days, read the signs you are losing too much blood during your period instead.

Common causes of spotting between periods

Ovulation bleeding

Some people have a little bleeding when they ovulate. It happens to about 8% of women, at about the midpoint of the cycle, which is close to day 14 in a 28-day cycle. Ovulation spotting usually lasts a day or two, is often pink or light red, and is usually not enough to need a tampon. A drop in oestrogen (estrogen in the US) after the egg is released can make a small part of the womb lining come away.

Ovulation can also cause a one-sided ache for a short time. To learn how that pain is different from endometriosis pain, read ovulation pain vs endometriosis.

If mid-cycle bleeding is new for you, or it does not fit this pattern, get it checked. It can also come from an infection or a polyp.

Hormonal contraception

Hormonal contraception, such as the pill, is a common cause of bleeding between periods. This is often called breakthrough bleeding. It is more likely when you start a new hormonal method, switch methods or miss a pill. It is also more common with low-dose pills and with pills you take back to back to skip periods. Hormonal IUDs and implants can cause it too.

Many people with endometriosis or adenomyosis use hormones as treatment, and spotting is common at the start. In studies of a hormonal IUD for adenomyosis, most people had spotting at first, and later their bleeding got lighter or stopped. Our guide to Mirena for endometriosis and adenomyosis explains what the first 6 months can look like.

Do not stop a treatment or a contraceptive on your own because of spotting. Ask your doctor or nurse first. If you missed pills, follow the missed-pill advice in your pill leaflet.

Polyps and fibroids

Small growths in and around the womb, such as polyps or fibroids, can cause bleeding between periods. Polyps on the cervix can also bleed after sex.

Infections

Sexually transmitted infections such as chlamydia can cause bleeding between periods or after sex. Pelvic infections can also cause spotting. A test is the way to find out.

Endometriosis and adenomyosis

Endometriosis can lead to bleeding between periods. A typical pattern is spotting in the days just before a period starts. In one small study of women at an infertility clinic, endometriosis was found in about 89% of those with 2 or more days of spotting before their period, and in about 26% of those without it. That study was small, so this sign alone does not prove you have endometriosis. It is still worth telling your doctor about.

Adenomyosis is when the womb lining grows into the muscle wall of the womb. It mostly causes heavy periods; bleeding between periods is less common. For the full list of signs, read adenomyosis symptoms.

Pregnancy

Light bleeding can happen early in pregnancy, when the embryo implants or from a sensitive cervix. It can also be a sign of a miscarriage. If there is any chance you are pregnant, do a pregnancy test.

Bleeding with tummy pain after a missed period can be a sign of an ectopic pregnancy. See the urgent signs below.

Other causes

Less often, bleeding between periods or after sex can be a sign of cancer. This is the main reason to get unexplained bleeding checked, even when it is light.

What to note before your appointment

A short record helps your doctor find the cause faster. Write down:

• the dates of each spotting day and the first day of each period
• the colour and amount (on toilet paper only, a liner, or a pad)
• the day of your cycle the spotting starts
• if it happens after sex
• your contraception or hormone treatment, when you started it, and any missed pills
• any pain, where it is and how bad it is (0 to 10)
• any chance you could be pregnant
• the date of your last cervical screening (smear test)

Two or three cycles of notes show a pattern, such as spotting always mid-cycle or always in the days before a period. Endolog, the endometriosis pain and symptom diary, is a free download with an optional in-app subscription. You can log bleeding, pain and other symptoms each day and share a report at your appointment.

What happens at the appointment

A doctor or nurse will ask about your symptoms and your medical history. They may offer:

• a pregnancy test
• a blood test
• a test for STIs
• an examination of your vagina and cervix

If you need more tests, you may get an ultrasound scan, a colposcopy (a closer look at the cervix) or a hysteroscopy (a thin camera to look inside the womb). Treatment depends on the cause.

When to see a doctor

Book an appointment with a GP, your gynaecologist or a sexual health clinic if:

• you bleed between periods or after sex, even if it is light
• you bleed after the menopause, which is when you have had no period for more than a year. Postmenopausal bleeding needs a check by a GP, because it can be a sign of cancer
• breakthrough bleeding on hormonal contraception lasts more than three months
• you also have pain or a fever, or you are pregnant

When to get help urgently

Get an urgent GP appointment or call NHS 111 (or your local urgent care line) if you have recently missed a period, have unusual vaginal bleeding and have pain anywhere in your tummy. This can be a sign of an ectopic pregnancy and needs a check as soon as possible.

Related guides

• Ovulation Pain vs Endometriosis: How to Tell the Difference
• Signs You're Losing Too Much Blood During Your Period
• Adenomyosis Symptoms: Heavy Periods, Pain and What to Track
• Mirena for Endometriosis and Adenomyosis: What to Expect